"Give young people and gay men free condoms to reduce STIs" is how the Guardian reports NICE's latest draft guideline on condom distribution schemes. A ScHARR team carried out the cost-effectiveness analysis used by the NICE public health advisory committee when making its recommendations.
NICE wanted to understand the potential costs and benefits of schemes which distribute condoms in order to prevent sexually transmitted infections (STIs). ScHARR developed an economic model which took into account the effects on both health and savings to the NHS of these schemes in four populations.
For young people, we replicated the C-card scheme, which is already running in many areas of the UK (for example, the pan-London Come Correct scheme) and aims to increase condom use and reduce condom failure among those aged 13-24. Our analysis estimated that a scheme like the C-card would be cost effective, with a cost of around £17,000 per quality adjusted life year (QALY) gained. Averting cases of HIV was particularly beneficial, since HIV not only reduces quality of life and life-expectancy of patients considerably, but also has high costs to the NHS.
There was limited published evidence from trials of condom distribution schemes on which to base these analyses. For MSM, black Africans and the general population there was a lack of evidence for the effectiveness of schemes in these populations. However, threshold analysis suggested that schemes could be cost-effective in both MSM and black Africans even at quite a high cost (£10 per person in the target population), due in the main to the higher prevalence of HIV in these groups.
Our full report can be viewed here.